Pulp And Periodontum Disease Flashcards
Caries pathway
IN ORDER
Caries
Pulp hyperaemia
Acute pulpitis
Then either acute apical perio/chonic pulpitis
Acute apical abscess
To and fro between various states
Chronic apical infection - after abscess subsides
Or can be a chronic sinus
Then can become apical radicular cyst
Which can be infected
Clinical features of pulp hyperaemia
- pain lasting for seconds
- pain stimulated by hot/cold or sweet foods
- pain resolves after stimulus
- caries approaching pulp but tooth can still be restored without treating pulp
- sharp pain
Clinical features of acute pulpitis
- caries reaching the pulp
- constant severe pain
- reacts to thermal stimuli
- poorly localised pain
- referral of pain - thinks its other tooth
- no (or minimal) responce to analgesics - cant get to pulp chamber
- open symptoms (exposed pulp) less severe
Diagnosis of acute pulpitis
- history
- visual examination
- usually not TTP - as PDL not inflammed yet
- pulp testing is equivocal
- radiographs
- diagnostic LA
- removal of restorations
Diagnosis of acute apical periodontitis
- easy to make
- TTP
- non vital tooth (unless traumatic)
- slight increase in mobility
- radiographs
- loss of clarity of lamina dura
- radiolucent shadow - may indicate an old lesion e.g. flare up of apical granuloma
- delay in changes at apex of tooth
- widening of apical periodontal space
What is acute apical periodontitis
Infection spreading out of tooth through apex
Inflammation of pulp and periodontal tissue
Causes of traumatic periodontitis
Parafunction
Diagnosis of traumatic perio
- clinical examination of occlusion
- functional positioning
- posturing
- TTP
- normal vitality
- radiographs
- may show generalised widening of Periodontal space
Treatment of traumatic periodontitis
- occlusal adjustment - if tooth too high
- therapy for parafunction - gumsheild
Organisms involved in abscess
-anaerobes
-poly microbial
Symptoms of acute apical abscess
- severe unremitting pain
- acute tenderness in function
- acute tenderness on percussion
- no swelling, redness or heat yet until it perforates through bone
Symptoms of acute apical abscess after it perforates through bone
- swelling redness and heat (in soft tissues) become increasingly apparent
- as swelling increases pain returns
- initial reduction in TTP of tooth as pus escapes into soft tissues so release of pressure
Potential spaces infection can spread to
- submental space
- sublingual space
- submandibular space
- buccal space
- infraorbital space
- lateral pharyngeal space
- palate
Treatment for acute apical abscess
- soft tissue incision intraorally
- soft tissue incision extraorally
- remove source/cause
- extract tooth
- pulp extirpation
- periradicular surgery
this should help body to overcome infection
if they cant then antibiotics may be needed
5 cardinal signs of inflammation
- heat
- redness
- swelling
- loss of function
- pain
Reversible pulpitis
- denotes level of inflammation in which returning to a normal state is possible if noxious stimuli removed
- mild - moderate tooth pain when stimulated, no pain without stimulus, subsides within seconds, no mobility, no pain on percussion
What is irreversible pulpitis
- higher level of inflammation where pulp has been damaged beyond point of recovery
- sharp throbbing severe pain upon stimulation, may be spontaneous or occur without stimulation, pain persists after stimulation removed, RCT or extraction
Assessment of need for antibiotics
Local and systemic
Local
- airway compromisation
- dysphagia
- trismus
- lymphadenitis
- location (e.g. FOM)
systemic factors
- immunocompromised patients
- aquired causes - HIV
- drug induced - steroids, cytostatics
- blood disorders - leukaemias
- diabetes - poorly controlled
- extremes of ages - poor immune system
Periapical granuloma
- chronic apical periodontitis
- mass of chronically inflamed granulation tissue at apex of tooth (plasma cells, lymphocytes and few histocytes with fibroblasts and capillaries)
- not a true granuloma because not granulomatious inflammation! (note that granulomatous inflammation has epithelioid histocytes mixed with lymphocyes and giant cells)
What is chronic sinus
- infection around apex of tooth
- abscess perforates through bone and soft tissues and drains into the mouth
- chronic blister
- not much pain but bad taste
Aetiology of apical radicular cyst
- caries, trauma, periodontal disease
- death of pulp
- apical bone inflammation
- dental granuloma
- stimulation of epithelial rests of malassez
